Melissa McIntosh (Lindsay, Liberal Party, Shadow Minister for Energy Affordability) Share this | Link to this | Hansard source

In Australia, 1.5 million people live with diabetes. This is one of our country's most serious and important health issues for governments to address. The health committee's diabetes report, The state of diabetes mellitus in Australiain 2024, was tabled a few months ago in parliament. The report uncovered the growing prevalence of diabetes right across the country. It is a public health imperative that we take immediate action on every form of diabetes that impacts the lives of Australians.

I note the report acknowledges that type 1 diabetes can be triggered by COVID-19. It reads:

As part of the inquiry, the Committee heard evidence discussing the possibility of a COVID-19 infection being an environmental trigger that could influence the development of Type 1 or Type 2 diabetes. Multiple submitters, including the Department of Health and Aged Care, referenced emerging evidence suggesting that there may be a link between COVID-19 and new-onset Type 1 and/or Type 2 diabetes.

I think the research is now clear that this is the case. As the mother of a son who developed type 1 diabetes shortly after having COVID-19 in 2022, it is heartening to know that this is being taken seriously by the committee. I would like to take this opportunity to thank the work of the incredible medical researchers who continue to investigate the triggers of autoimmune diseases and how we can best prevent, diagnose and manage these occurrences.

As the deputy chair of the committee at the time of the inquiry, it was my strong desire that we maintain a tight focus on type 1 diabetes and, in particular, its impact on young people. Regarding type 1 diabetes, I support all the recommendations that we handed down in the report. The report recommends further research funding into diabetes within the Australian context. This is needed for those with type 1, where research is the only way to a cure.

The report also calls for more diabetes educators. The public health system is extremely stretched. As parliamentarians, we all know this from the many stories we hear weekly from constituents. With my son's type 1 diagnosis, I experienced firsthand the need for more diabetes educators. Nepean Hospital, in my electorate, had only one type 1 diabetes educator for new patients. The story is the same right across Western Sydney for those with type 1. The daily work of diabetes educators is so important for those who have just been diagnosed, as it will be throughout their life.

In terms of medical technology, there is a recommendation to extend constant glucose monitoring, CGM, devices to all. Regarding insulin pumps, we've seen the Albanese Labor government cut choices available to those with type 1 to one product. This must change now, and we acknowledge this need in the report. For those with type 1, choice is pivotal in ensuring they have access to the devices that work for them. I've strongly advocated for those with type 1 diabetes to have access to fully subsidised devices, given that those who are now aged 21 and above must make co-payments for these life-saving and needed daily products.

Choice in devices and ongoing advances in medical technology is life saving for those managing type 1 diabetes, and this cannot be understated. We need such ideas to be taken up by government so that the lives of those with this chronic illness are made easier. Every kid with type 1 deserves a device that works for them so they can play sport with their friends in the playground and not worry and can participate as an athlete at even the most elite levels of sport.

There is no doubt that Australia has an epidemic in relation to type 2 diabetes. Some of the highest rates of type 2 diabetes are in Western Sydney, including in my own electorate of Lindsay, spanning from Penrith to St Marys. Urgent action needs to be taken to change this. This action spans all three levels of government, as well as academia and community stakeholders. In terms of type 2 diabetes, I strongly support early intervention, especially the promotion of physical activity and healthy eating habits, which should be ingrained in the primary school curriculum. Type 2 diabetes is on the rise in our kids, and we need to counter this immediately. If we do not act now to stop the growth of type 2 for the next generation, we are going to see poorer life outcomes for many kids in low socioeconomic areas and, in particular, more pressure applied to our public health system.

It is time for a new public health campaign to encourage healthy, active lifestyles with a focus on the prevention of type 2 diabetes. As the member for Lindsay, I started a healthy active living network in my community when I was first elected in 2019. It is a passion of mine to ensure that every child and adult has a sport they want to play that is accessible to them or that they even get out and about and do the river walk along the Nepean River.

We need every policy lever pulling in the same direction in order to combat type 2. We need governments to step up and tackle this issue head on. Other factors like diet and education are critical in all age groups to stop more diagnoses of type 2. Low carbohydrate diets need more attention in this respect. As a former shadow assistant minister for mental health and suicide prevention, I fully support the recommendation for the government to review access to juvenile mental health services for those with diabetes. Kids with type 1 often feel disengaged and feel they can't participate in so much. This is the same, of course, for children with type 2. There is a psychological element of diabetes that our young people must combat every day. The report noted that diabetes patients make more than 180 diabetes related decisions a day. That is extraordinary.

I thank my fellow committee members for their work on this report and for their expertise—many are doctors, including the chair and my good friend the member for Macarthur—and I thank others like the members for Higgins, Kooyong, Mackellar and Robertson. I also want to thank the member for Berowra for taking on the deputy chair position of the committee, as I became a shadow minister and was made a supplementary member for the remainder of the inquiry. I want to especially thank the members of the committee from Western Sydney, including the members for Hughes, Macarthur and Werriwa. You all have an acute understanding of how type 2 impacts our communities and our health systems. I also want to acknowledge the late member for Dunkley Peta Murphy for her contribution to the committee's work.

Finally, I would like to give a shout-out to a clinician on the frontline in Western Sydney, Dr Kathryn Williams, whose work on obesity in its most severe forms is extraordinary. I thank her for her ongoing advocacy in type 2 and obesity research as well.

Graham Perrett (Moreton, Australian Labor Party) Share this | Link to this | Hansard source

I've been involved with the Parliamentary Friends for the Prevention of Diabetes for my entire time in politics, and I was elected in 2007. I'm currently co-chair with my good friend the member for Grey. We wanted to name that group 'the enemies of diabetes', but we weren't allowed to. Over the past year, I've had an additional focus, as I was seconded for membership of the health committee for the parliamentary inquiry into diabetes. This year-long inquiry had nearly 500 submissions, and the committee met with stakeholders all around the country. I want to do a particular call-out to Dr Mike, who chaired that committee, and acknowledge all of the other committee members who were so warm and welcoming. To the member for Macarthur, Dr Mike Freelander: this report is a testament to your incredible leadership, and I really want that to be on the record. It is a real recipe for how this nation can go forward. I want to thank you. Thank you for lending me this report—my prop. I'll give it back to Dr Mike, who did an incredible job.

That report, The state of diabetes mellitus in Australia in 2024, only released last month, comes at a time when diabetes is the fastest growing chronic or noncommunicable disease in Australia. It's a tsunami. The report has 23 recommendations and highlights the health and economic costs of diabetes. It also provides insight into the proposed next steps in handling what Diabetes Australia calls 'the epidemic of the 21st century and the biggest challenge confronting Australia's health system', which is an incredible statement. We know that diabetes affects people in all communities across the country, some disproportionately, and that access to services is not equitable. I developed this interest in diabetes because my mum was a type 2 diabetic. The report points out that to combat diabetes we need to focus not only on prevention but on education, on agriculture and on manufacturing, amongst many other things.

Today I'd like to focus on the report's fourth recommendation, which states:

The Committee recommends that the Australian Government implements a levy on sugar-sweetened beverages, such that the price is modelled on international best practice and the anticipated improvement of health outcomes. The levy should be graduated according to the sugar content.

In December 2022, the World Health Organization released its first global tax manual for sugar sweetened beverages, also known as SSBs. As of February 2023, 106 countries and territories had implemented a sugar levy. These included the United Kingdom, France, South Africa and many of our Pacific neighbours. The application of a levy on sugar sweetened beverages is proven to reduce demand and have a positive effect on health outcomes. I was shocked when I learned that Australians drink more than 2.4 billion litres of sugary drinks each year. That's an average of 92 litres per person. I think my sons are doing their bit to keep those averages up. These are drinks like flavoured milk, soft drinks, energy drinks, fruit juices and vitamin waters. They are flavoured with sweeteners such as sucrose, high-fructose corn syrup or fruit juice concentrate. The Australian Medical Association describes them as containing 'a high number of liquid calories but providing almost no nutritional benefit'. People who regularly consume these kinds of drinks have an increased risk of developing debilitating and even terminal health issues. These can range from dental cavities to weight gain and obesity, heart disease, stroke and type 2 diabetes.

There are approximately 1.5 million Australians living with all types of known, diagnosed diabetes. Eighty-seven per cent of these people have type 2 diabetes. That's a staggering 1.3 million Australians. Diabetes Australia believes a further half a million people are living with undiagnosed type 2 diabetes. The inquiry showed that treating type 2 diabetes is placing a significant burden on Australia's health resources. It affects numerous branches of medicine, such as obstetrics, paediatrics—which I think Dr Mike might know a little bit about—neurology, cardiology vascular surgery, ophthalmology and geriatrics. Type 2 diabetes has strong genetic and family related risk factors, but it is also often caused by modifiable lifestyle choices. People can slow or stop the progression of the condition by changing their diet and increasing the amount of exercise that they do. Being overweight can contribute to the risk of developing type 2 diabetes, and the introduction of a levy on SSBs would help work to diminish this risk.

Last year the Australian Medical Association had this to say about a sugar levy:

Our analysis projects this tax would reduce consumption by 31 per cent by 2025-26, and is estimated to result in 16,000 fewer cases of type 2 diabetes, 4,400 fewer cases of heart disease, and 1,100 fewer cases of stroke. It is a simple but effective way to improve the lives of Australians.

The AMA also told the inquiry:

To effect a change in SSB consumption, both a clear message for consumers that the product is unhealthy, and a tangible deterrent are warranted. A tax can deliver on both counts by creating a price signal that the product is unhealthy, and reducing consumption through higher prices (and therefore lower affordability). Furthermore, an appropriately designed tax can also incentivise manufacturers of SSBs to reformulate their products to contain less free sugar.

That is actually what has happened throughout the world. Manufacturers are still making drinks, still putting them into supermarkets, still selling them to customers, but there is just less sugar consumed.

Of course, simply implementing a levy on SSBs will not solve the type 2 diabetes problem. I'm a big believer in community infrastructure that gets communities moving, because of all the benefits that flow from that: communities are safer, there is less crime, there are better connections and there is less chance of any fear-and-division campaign taking hold in a community where people are out there exercising together, sharing meals, making friendships, watching sports together. There are numerous other factors—such as an active lifestyle and education on and access to healthier food choices—at play. However, reducing sugar intake through a levy on sugar-sweetened beverages is an important piece of the puzzle and one that I believe should be implemented. I say that as someone coming from the Sunshine State, with all of my in-laws living in Far North Queensland. Dr Mike Freelander, the member for Macarthur, again I thank you for your leadership on the health committee and for letting me work with the committee on such an important inquiry. I commend the document for everyone to read.

Monique Ryan (Kooyong, Independent) Share this | Link to this | Hansard source

I too would like to acknowledge the great work done by the member for Macarthur, the Chair of the Standing Committee on Health, Aged Care and Sport, in undertaking this inquiry and bringing the report to completion. It is a really important one. I'd also like to acknowledge my medical colleagues on the health committee, the members for Higgins, Mackellar and Robertson, and the two deputy chairs of the committee, the members for Berowra and Lindsay, and other members of the committee but particularly the former member for Dunkley Peta Murphy, who is much missed by all of us on that committee.

A division having been called in the House of Representatives—

Sitting suspended from 17:09 to 17:20

One in 20 Australians—that is, 1.5 million people—lives with diabetes. That is a number which continues to increase. Unfortunately, and terrifyingly, this country now faces an epidemic of diabetes. Type 2 diabetes is by far the most common form. In Australia it is much more likely to affect people of lower socio-economic standing. They're people who often have less access to clean water and affordable fresh food, have less time and less space for regular physical activity and often have less access to good quality health care.

In particular, First Nations peoples globally, but particularly in Australia, have a frighteningly high incidence of diabetes. They develop it at a younger age, and their progression to often-life-threatening complications is frighteningly rapid. Diabetes is the leading contributor to the gap in life expectancy between Indigenous and non-Indigenous Australians. Aboriginal and Torres Strait Islander people are nearly five times more likely to be hospitalised for diabetes related complications. Diabetes is the leading cause of death for Aboriginal people in the Northern Territory. The reasons for this are complex, and they include both genetic predisposition and a whole raft of socio-economic factors.

But many of our policy settings could be adjusted to immediately improve protections for First Nations and other vulnerable Australians. The first of these is the urgent need for action on our diet. Australians eat too many ultra-processed foods and too many foods with added sugar and hidden chemicals. Unhealthy foods represent one-third of Australian children's diets. One in four Australian children is either overweight or obese. Most Australians just don't understand how much sugar is added to our food. The regulation of food manufacturers in this country is rubbish, whether we're talking about dietary codes for infant formulas or the health star ratings we apply to other foods. Parents often think they're feeding their kids healthy food, but products which are labelled as 'containing no added sugar' can still contain added sugars in the forms of gels, pastes or purees. Only 22 per cent of the infant and toddler foods stocked in Australian supermarkets meets the nutritional standards of the World Health Organization. In particular, many breastmilk substitutes, or what we call toddler milks or toddler formulas, are effectively just sugary drinks. Labelling codes for those drinks and for other foodstuffs in this country are voluntary.

Only 41 per cent of products on our supermarket shelves display health star ratings, and there's a reason for that: the manufacturers of healthy products use them as a marketing tool, but others, the unhealthy foods, just decide not to display a score. The star system is also problematic in and of itself, though. It doesn't distinguish between natural sugars and added sweeteners. It gives higher ratings to ultra-processed foods and lower ratings to whole foods. We urgently need a mandatory food labelling scheme which will provide accurate and clear health information to consumers when they buy food for themselves and their families.

The health committee also recommended that the Australian government implement a levy graduated according to the sugar content of sugar sweetened beverages; these are sports drinks, soft drinks, energy drinks and vitamin waters. These drinks cause weight gain but they have limited nutritional value. They carry calories but not much else. A levy on these soft drinks would encourage industry to reformulate those drinks, and it would lessen consumption in the same way that similar measures have decreased consumption of tobacco and alcohol in Australia.

More than 35 public health organisations have now asked the government to levy a sugar-sweetened beverage tax in this country. But the major political parties, sadly, are not listening. Data from 85 international jurisdictions has shown that sort of levy is effective in decreasing sugar consumption. In fact, a recent study in the US showed a 40 per cent decrease in gestational diabetes and a corresponding improvement in obstetric outcomes, like low birth weight, after imposition of a sugary drink levy. That was within a couple of years of that intervention.

Gestational diabetes is a real worry for Australians, because it affects not only the women who have it and who are at increased risk of developing type 2 diabetes in later life; it also has permanent and ongoing implications for the children who sit in the mum's tum while that mum has diabetes during pregnancy. Earmarking the revenue from a sugar-sweetened beverage levy would be an immediate way of identifying funds which could help with public health measures, and that would help engender public support for this concept.

It was a great privilege to be a member of the parliamentary committee which investigated diabetes in Australia, but I have to say that much of what we heard was confronting and difficult. It's very clear that this scourge is something that will be a huge challenge for all of our healthcare systems in the years to come. The efforts of that committee will be wasted if this government does not act on the committee's findings.

The committee visited some First Nations communities in which we saw people with minimal access to fresh fruit and vegetables and who couldn't access affordable, drinkable water. We saw communities where children were carrying around two-litre bottles of Coke because it was cheaper than the bottled water that was the only other source of fluid they could access. We could help those people and those communities in the simplest and most fundamental of ways. We could improve the regulation of the food and drinks industry in this country. But, if we don't, we will all bear the cost of that and the loss associated with this plague that the diabetes epidemic represents.

Mike Freelander (Macarthur, Australian Labor Party) Share this | Link to this | Hansard source

by leave—This report of the Standing Committee on Health, Aged Care and Sport took over 18 months, and we heard from people all around the country about the public health emergency that is diabetes in Australia. We know that there are approximately 150,000 people with type 1 diabetes, over 1.5 million people with type 2 diabetes and more than that number with prediabetes. It's a major public health emergency. We have seen that almost 50 per cent of presentations to our emergency departments are related to diabetes in some way, from complications like renal failure, cardiovascular disease and retinal disease with visual impairment to all the other long-term complications of diabetes, leading to huge pressure on our health system. Peripheral vascular disease, which is preventable, is often a presentation of people with type 2 diabetes. We are doing more amputations in Australia than we should be because of this scourge of diabetes. It's a huge burden on our health system.

This inquiry is important, as it looks at how we could change this narrative and trajectory, because, if we don't, our health system will not be able to cope. We've already seen in areas like the Northern Territory the scourge of renal failure even at a relatively young age. This is people in their 20s with renal failure requiring dialysis because of type 2 diabetes. The trajectory is very bad. In my medical lifetime, we've seen persistent increases in life expectancies every year. In the lifetime of my parents and grandparents, similar has been true. But we are now in a time where, in the developed world, life expectancies are plateauing. The increases in life expectancy that have been seen for over three generations are now changing. In some states in America, they're actually seeing decreases in male and female life expectancies.

One of the big causes of this in the developed world is diabetes. In particular, diabetes is affecting those in disadvantaged communities. We see this in Australia. Type 2 diabetes—not type 1 diabetes—tracks disadvantage. We see this in the outer suburbs of our major capital cities. We see it in western and south-western Sydney in electorates like mine, Macarthur, and in electorates like Fowler, Werriwa and Lindsay where there are very high incidences of diabetes. It is putting enormous pressure not just on our health system but also on our social security system and even on our education system, with many adolescents now presenting with obesity and type 2 diabetes. It is very prevalent, as has already been mentioned, in our Indigenous community. It's now appearing in our Pacific islander community and in our subcontinental communities. The increasing incidence of obesity and type 2 diabetes is causing major health complications.

I started the type 1 paediatric diabetes clinic at Campbelltown hospital 30 years ago. It was becoming apparent then that the management of diabetes was very complex and required a team approach. It was difficult to provide that in private practice. We started that type 1 diabetes clinic at Campbelltown hospital many years ago, in the 1990s. Then, about 10 or 12 years ago, we started to see an increasing number of children presenting with obesity and type 2 diabetes. As we travel around our communities in outer metropolitan areas, rural areas and regional areas, and as we travel to Indigenous communities in remote areas, in particular, we are finding this problem of early onset type 2 diabetes. This is causing an early trajectory towards complications like vascular disease, blindness and kidney failure. These communities are now being devastated by the numbers of adolescents and young adults who are presenting with type 2 diabetes and all its complications. This trajectory has to be changed. It's bad for the communities, it's bad for the wider Australian society and it's something that we need to reverse if we are going to see a return to continuing increases in life expectancy in a well-developed and wealthy society like Australia—hence, the report.

The report has 23 important recommendations that have already been spoken about. Some are controversial and some are not, but they need to be taken in their entirety. We don't want this report to be left on a shelf gathering dust. It's now my job to take this around the country, and I'll be speaking to state health departments and state health ministers about how we can get implementation of the recommendations from this inquiry. As I said, there are 23 of them. Some of them require some investment, but that investment will reap financial rewards if we can turn this epidemic around. That is now my job. It is a public health emergency, as I've said, and it requires a public health response which can only be led by governments from all persuasions, from local to state to federal.

I think that if we are going to turn this around it is going to require action as soon as possible. That is going to depend on many of the committee members who gave their time and their efforts to the inquiry. In particular, I would like to thank the co-opted members—Graham Perrett, the member for Moreton, and Sophie Scamps, the member for Mackellar—as well as my medical colleagues and non-medical colleagues on the committee. I'd like to also pay tribute to Peta Murphy, who was a member of our committee until her death. She understood the social determinants of health very well, was committed to our inquiry and was a big part of our recommendations.

I'd like to thank those who provided submissions to our inquiry, from Diabetes Australia to JDRF. All of the major medical institutes provided supports for us. In particular, I'd like to single out the Grattan Institute, who provided a very comprehensive view of the social issues involved with type 2 diabetes and obesity. And there were all the other institutes in places like Darwin in the Northern Territory, where the Menzies Institute was able to provide very good evidence of the difficulties that diabetes was causing in remote and rural communities.

I would like to thank all the kind words that my fellow committee members have said about the report, and about me in particular. But I'd like to stress that this is a report of the whole committee, and I'm incredibly grateful for all the work they put into what I think is a very important inquiry and what are very important recommendations. I am committed to making sure that we have uptake of those recommendations. I know the health minister has looked very favourably upon our recommendations and is doing his best to help with the adoption of the inquiry's recommendations.

We know that prevention has to be the main aim. If we continue on this trajectory of increases in the number of people with diabetes, our health system will be put under unbelievable pressure and other health priorities will suffer. I commend the report to the parliament and I commit to continuing to impress upon those in power the importance of taking up these recommendations.

Debate adjourned.

Federation Chamber adjourned at 17:37